Professional Ethics and Law in California, 2nd Edition _ ____________________________________________
Suicide: Right to Choose Versus Duty to Protect Sometimes a mental health practitioner may be faced with a choice between a client’s right to choose suicide and the duty to protect his or her life. The request by the emotionally stable and rational terminally ill client is a good example of a situa- tion that is not as “cut-and-dried” as that involving a severely depressed young woman contemplating suicide. Would one client deserve individual consideration and thus not be assessed for possible hospitalization over the other? Most workers choose this profession because it supports respect for the strengths and abilities of clients, and thus their ability to learn, make good decisions, and be self-sufficient. But aside from laws prohibiting assisted suicides, workers also rely on intuition and judgment in determining whether to take action to protect a client from harm. This scenario blurs the line between respect for the client’s wishes and society’s obligation to protect. It also raises the issue of client autonomy versus the professional obligation to prevent discrimination. Thus, it is essential that mental health practitioners establish clear procedures that ensure impartial assessment while valuing client autonomy and individual treatment. Since laws and professional codes of ethics are not always clear and do not always spell out our specific duties and responsibilities, it is recommended that workers not only do everything to assist clients in taking advantage of any options to alleviate their distress, but also rely on practice guidelines that call for: • Careful evaluation, such as the client’s ability to make rational choices based on their medical and mental state and social situation • A good therapeutic alliance • Consultation A controversial issue is the duty to protect, or the duty to warn. It addresses the degree of action that a professional— including social workers—must take if a client informs the practitioner that he or she has a plan to harm someone else, and the duty to warn that individual. Laws vary throughout the 50 states. In California, the case of Tarasoff v. Regents of the University of California became a legal milestone in 1974, when the state’s Supreme Court ruled that mental health professionals have a duty to warn potential victims. Tatiana Tarasoff was murdered by a stalker, who had been consulting a psychologist at the Cowell Memorial Hospital, which was associated with the University of California at Berkeley. In the stalker’s final session before breaking off therapy, he announced that he intended to kill Tarasoff. Although the psychologist alerted the police that the client should be hospitalized, the police released him after he promised to stay away from the young woman. The psychologist’s supervisor ordered that the psychologist make no further attempts to detain the client, and nobody warned Tarasoff of the threats. The victim’s parents sued the psycholo- gist and the university.
• Manage time effectively • Acknowledge clients’ time constraints • Check record keeping
• Return phone messages in a timely manner • Avoid being late for sessions or meetings • Be dependable • Make outside resource information available to clients ETHICAL RESPONSIBILITIES TO CLIENTS This illustration highlights the complexity of ethical responsibility to clients. • A depressed 80-year-old client, suffering from the painful, debilitating effects of arthritis, asks Rene, his mental health therapist, for information on assisted suicide. He tells her that he only needs help downloading information from the Internet and then it is his right to weigh the options of proceeding. Rene believes the client’s depression is directly related to the pain, because the client is otherwise of sound mind, and therefore has a right to determine his future. Commitment Client interests are primary. The foregoing example epito- mizes the difficulties often faced by mental health practitioners when the principles of law, personal belief, professional codes of ethics, client need, and cultural and societal norms intersect and at times contradict one another. The professional is then faced with a conundrum that offers a multitude of potential decisions, actions, and consequences. We will discuss more about how the worker can best weigh all these considerations to make the most ethical decision later in this course. Self-Determination Another standard that strongly reflects the mental health practitioner’s commitment to a client is that of self- determination. Professionals have an obligation to support and assist clients in accomplishing their goals, only deviating from this standard when a client’s goal puts them or others imminently at risk. Defining risk can be difficult; most mental health profes- sionals cannot argue that suicide or homicide fail to present clear risk to the client or to others. Other client choices such as staying in an abusive relationship or living in squalor or on the streets may challenge a professional’s personal values and sincere desire to protect—also known as “professional pater- nalism” (Reamer, 2006). In the absence of clear and present harm, the client has a right to choose his or her own path and make his or her own decisions, whether we agree or disagree.
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